Provider Demographics
NPI:1700080306
Name:WRIGHT, BRANDY WATSON (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:WATSON
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BRANDY
Other - Middle Name:MICHAD
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:300 JAMES CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4544
Mailing Address - Country:US
Mailing Address - Phone:313-308-5015
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-413-8687
Practice Address - Fax:312-413-5604
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093605207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3850432192OtherMYUTMB 3850432192-COMMERCIAL NUMBER